SHELLY MARIE KENNEDY-GONZALEZ LPC
NPI 1679923320
Counselor - Mental Health in Broken Arrow, OK

Q: What is Shelly Kennedy-gonzalez's NPI number?

The NPI number for Shelly Kennedy-gonzalez is 1679923320. It was assigned to this individual provider in the NPPES registry on June 14, 2016. The provider is also known as Shelly Bilby-Logan Lpc.

Q: What is Shelly Kennedy-gonzalez's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Active since June 14, 2016PECOS EnrolledAccepts Medicare Assignment

2017 S ELM PL STE 104, BROKEN ARROW, OK 74012(918) 379-4431(918) 328-2380 Get Directions Write a Review

NPPES record last updated: November 8, 2025. Verified against the NPPES registry weekly; last sync: August 23, 2026.

Record update history: Nov 8, 2025, Sep 8, 2025, Dec 3, 2024 and 2 more (5 updates tracked since 2016).

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About Shelly Marie Kennedy-gonzalez Lpc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHELLY MARIE KENNEDY-GONZALEZ LPC (NPI 1679923320) is an individual mental health provider in Broken Arrow, Oklahoma, licensed in Oklahoma (06888) and active in the NPI registry since June 2016. She is enrolled in Medicare PECOS, maintains a secondary practice location in Tulsa, and is a graduate of Other (2016).

NPPES Registry Identity

NPI1679923320

Entity TypeIndividualFemale

Primary Taxonomy101YM0800X

Provider Legal NameSHELLY MARIE KENNEDY-GONZALEZCredential: LPC

Location Address2017 S ELM PL STE 104Broken Arrow, OK 74012-7034

Mailing Address6931 S 66th East Ave Ste 200Tulsa, OK 74133-1765 · (918) 379-4431 · Fax (918) 328-2380

Phone(918) 379-4431

Fax(918) 328-2380

Sole ProprietorNo

Medical School CMSOtherGraduated 2016

Enumeration DateJune 14, 2016

Last NPPES UpdateNovember 8, 20255 updates tracked since enumeration

NPPES CertifiedNovember 8, 2025

✔ NPI 1679923320 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers

Taxonomy Code101YM0800X

License✔ Licensed in OK · 06888

Also ListedCounselorTaxonomy 101Y00000X · License 6888 (OK)

2017 S ELM PL STE 104, Broken Arrow, OK 74012

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Other Names 1

Former Name (1)Shelly Bilby-logan Lpc

Secondary Practice Location 1

Location 16931 S 66th East Ave Ste 200Tulsa, OK 74133-1765 · Phone (918) 379-4431 · Fax (918) 328-2380

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Home State Health, Ambetter from Sunflower Health Plan and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Shelly Marie Kennedy-gonzalez Lpc is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID5395184451

PECOS Enrollment IDI20240422003081

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SUMMER ANN MINOR LPC-C

Counselor (Mental Health)